=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710088216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHAMPTON DERMATOLOGY ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 NONOTUCK STREET SUITE 107
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-586-5798
-----------------------------------------------------
Fax | 413-585-0587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 NONOTUCK STREET SUITE 107
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-586-5798
-----------------------------------------------------
Fax | 413-585-0587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | BRUCE M. GOLDSTEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 413-586-5798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------